I can’t expect MDs to do anything that might reduce their guild; privileges, but it’s plausible that insurance companies and government might want things to reduce expense. That could include public health measures and improved self-screening approaches.

My father is a retired dentist. Back when fluoridation was new he campaigned heavily for it. Some other dentists said that he shouldn’t because he’d be cutting back on business. “Cutting his own throat.” But he argued that there would be plenty of dental business even after fluoridation, and he was right.

Currently, more things to make people ill won’t increase medical payments much. The money just isn’t there.

As you can see from all these replies, “retired” means I have a lot of spare time. You sound a lot different now than in your original post. Plumbers=doctors is not only right, it is exactly what I said (”guild’). Your attitude seems a bit naive in that you wish for doctors to promote a system that would somehow transfer the benefit of their experience to the patients without a paid encounter. That’s where the guild concept comes in. Doctoring is a job, which requires a incredibly long apprenticeship. The doctors plan for you to pay for the service, as much as the traffic will allow, for as long as you are willing to do so. Just like plumbers.

I did my own lit search because that was what I knew how to do. I had access to a medical library, so I could get any paper that wasn’t too obscure. I knew how to do lit searches quickly and efficiently and I was quick to pick up the material.

But that was no substitute for direct experience. I had no idea that my girlfriend’s symptoms would subside in 6 months. It wasn’t true for the people in the studies. But those people were chosen because their symptoms were serious enough to deserve careful attention.

I could tell after the fact that she was a plausible candidate for DVT. She was on estrogen, and was somewhat overweight. She got a bad bruise on a mountaineering trip and then drove long hours with no rest break. But I’d never seen it before.

The surgeon, however, gave DVT to over a hundred people a year. He’d seen a lot of cases and he knew what to expect.

I’m not complaining about that. I’m just pointing out that doctors are more like plumbers than they’re like scientists. When you call a plumber you don’t expect the latest scientific results in plumbing. You expect he has the judgement and experience to do the job, and if he doesn’t you hope he’ll refer you to somebody who does. Same with MDs. We currently have no way to transfer that judgement and experience over the internet or through medical libraries, either one.

I can imagine a way to begin to do that. We’d put all patient records into a database, with some attempt to allow anonymity. So then say you have flu symptoms. You put your symptoms into the database and it tells you about what happened to other people with symptoms like that. 97% of them had flue and got over it. A few had histoplamosis, a few went on to have coronary disease, a few had this or that other problem. So then you can reduce the search to people who’re around your age, and/or gender, and/or your geographical area, and/or whatever else is available, and maybe you get a different result — fuzzier but different.

Every few days the database could email you to remind you to tell it how you’re doing, and if you don’t respond it checks the death records etc to see if you can’t respond….

It wouldn’t substitute for the personal touch but it would provide a whole lot of data that anybody could mine. We have something like that now for insurers, but the data is mostly private and it’s organized around diagnoses more than symptoms and test results.

RU, that was my point. My understanding of statistics etc from my biomath training might give me a much better ability to understand randomized trials than most physicians — a large portion of them wind up not at all showing what the authors think they do.

But that’s no substitute for experience. I couldn’t look at her leg and tell whether her PPS was really serious. All I had to go on were a few pictures and a lot of wordy descriptions. The surgeon could tell at a glance that it wasn’t that bad because he had experience. He had DVT and PPS as complications for his surgery patients all the time.

I wouldn’t be surprised if I knew much more of the literature about those topics than he did. But that was no substitute for experience, and I knew it.

The medical guild has published all their information on the Internet. Good for the patients, bad for the guild.

It isn’t that simple.

Maybe my search was biased but I tried to include lots of randomness to pick up things I didn’t know I was looking for. I believe the bias was in the literature and not much in my search of the literature.

The prestigious surgeon we talked to had not publisned anything about DVT that I could find. But he had sufficient experience to say that her PPS would probably subside with no problems. And he turned out to be right. DVT was not a research interest for him, it was just a complication he saw a lot.